Healthcare Provider Details

I. General information

NPI: 1801872304
Provider Name (Legal Business Name): ARKANSAS CENTER FOR PHYSICAL MEDICINE & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5526
US

IV. Provider business mailing address

636 W BROADWAY ST
NORTH LITTLE ROCK AR
72114-5526
US

V. Phone/Fax

Practice location:
  • Phone: 501-374-1153
  • Fax: 501-374-6213
Mailing address:
  • Phone: 501-374-1153
  • Fax: 501-374-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number992
License Number StateAR

VIII. Authorized Official

Name: MRS. BRANDLYN MICHELLE FRENSLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-374-1153